| NPI | 1912306911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH4005) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN3414332) |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2014-08-15 |